Bridgingancoagulana -...
Transcript of Bridgingancoagulana -...
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Bridging an)coagulan)a
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To bridge or not to bridge? • Periopera(ve bridging an(coagula(on in pa(ents with atrial
fibrilla(on Douke(s et al, NEJM 22 juni 2015
• BRIDGE trial • RCT, dubbelblind, placebo-‐gecontroleerd • Periopera(ef stoppen van warfarine, bridging met dalteparine
of placebo
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• Inclusie: • Chronisch atriumfibrilleren of –fluOer • > 3 maanden VKA met INR 2.0-‐3.0 • Minimaal 1 CHADS2 risicofactor
• Exclusie: • Mechanische hartklep • CVA/embolie/TIA < 12 weken • Bloeding < 6 weken • Krea(nine klaring < 30ml/min • Trombocyten < 100 • Cardiale, intracraniële of spinale opera(e
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Methoden • 1813 pa(ënten
• Abdominale chirurgie 44% • Cardiothoracale chirurgie 17,2% • Orthopedische chirurgie 7,2%
• 89,4% opera(e met laag bloedingsrisico
• Studiemedica(e preopera(ef gemiddeld 5 doses, postopera(ef 16 (SD ±7.9
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Resultaten
• Mediane (jd tot trombo-‐embolisch event 19 dagen • Mediane (jd tot bloeding 7 dagen
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Toepasbaar?
• Geen IC-‐popula(e
• Geen cardiale chirurgie
• 35% gebruikt ook aspirine, door ca. 60% niet gestopt preopera(ef
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